To self-fund or not to self-fund, that is the question. As the fully insured market continues to get slammed by unreasonably large rates increases, more employers are looking to self-funding as an opportunity to escape the choke hold of ever-increasing premiums. Watching the popularity of self-funding grow is exciting, but I advise employers to proceed with caution. Self-insuring the health plan opens an employer to great opportunity, but looking to self-funding as the ultimate destination may bring great disappointment. Simply put, self-funding is a vehicle, not the destination. It is not the solution; it is an avenue providing an organization with the opportunity to do some incredible things with its health plan. Look at it this way: Without a destination in mind or a road map to get there, an automobile is useless. However, if you have a chosen destination with a clear set of directions to get there, an automobile becomes an efficient vehicle allowing you to arrive at your destination successfully.

In the case of self-funding, I hope your destination is control— control of costs and control of how health care services are purchased inside your plan. With that, I have some good news. There are employers out there who have already created the road map. There are industry rebels who are already helping self-funded employers successfully arrive at their destination ahead of everyone else. You see, if you research these employers and industry rebels, you will find they all share one thing in common. The status quo has no place in their world. Their road maps do not include shopping carriers, increasing deductibles or employee contributions. They do not focus on beating up vendors over administration fees and stop loss premiums. No, they all understand that self-funding is about control. They understand that to control costs, you must control claims. If controlling claims does not have an important role within your road map you could be in for trouble. Seventy percent to 80 percent of your overall costs reside here, so claims-focused strategies are a must. The best strategies focus on changing how the health care services are purchased. With that in mind, let's look at three strategies that will have your self-funded vehicle speeding to success.

Value-based primary care

A sound claims-focused strategy starts with giving your plan members access to value-based primary care. Value-based primary care is a model based on quality, not volume (like most primary care physicians we see today). It exists outside the typical insurance model. The payment structure is based on " membership fees," not network discounts, freeing up the physician to spend more time with the patient. Under a value-based primary care model, patients often spend 30 to 40 minutes with physicians. As a result, the quality of the visit increases, leading to a better diagnosis. In addition, the physician is not incented to refer specialty care downstream to a particular hospital or other medical facility. In fact, when specialty care is required, a physician under the value-based primary care model will help the patient access providers who are beacons for cost, quality and outcomes. This primary care model leads to effective treatment plans, a reduction in unnecessary procedures, and services provided at a fair price. Your plan members save money through better care while your health care costs drop. Direct primary care and onsite/near site clinics are two examples of value-based primary care.